20220907Gem State to Staff 1-18 DR 2 Attachment 2.pdf

,ffi,Report Of Sale And Application for Certificate of Title ITD 0502 (Rev. 09-14)
Supply # 01-807050-1
Control Number
This is not a Certificate of Title
- Must be Legible - ldaho Transportation Department - Division of Motor Vehicles flf) 7 777268
Any previous liens on the trade-in vehicle that is listed on this application for title will be satisfied in full by the dealer within 10 business days
unless the owner relinquishing possession has signed below.
l, the owner relinquishing possession, acknowledge that I am responsible for satisfying all liens wathin 10 business days (ldaho Code 49-1609A)x ,,",
! Rebuilt Salvage E Previous State Brand E Reconstruct ! Repaired E Otner
-Previous ldaho Title No lst Vehicle or Hull ldentification No 2nd VIN lf Assigned
.9
,s
6E
.9
Year lMake Body Type Model Description Color (P.imary/Secondary)
l-uel lype lfength wicttr HullMaterialWheel Base Weight Horsepower Propulsion
Odometer Readino Odomeler Status
E Aclual tr tn excess
E NorAcrua tr No!9y99 D EIglqL
Odometer Reading Date Prevous State Previous State Brand Previous State Title No
Type of
Sale n New Ekused n Demo n Courtesy Delivery ! Lease ! Rental
Owner #1 Full Legal Name (Last, First, Middle) or Business Name ldaho Driver's License Number or SSN / EIN if Business Eor E And
tr LSR tr DBA-or tr A,d
tr LSE tr DBA'oro
o;
tl.
ry Lasl, First, Middle) or Business Name ldaho Drivor's License Number or SSN / EIN if Business
lOwner #3 Full Legal Name (Last, First, [,'tiddle) or Business Name ldaho Driveds License Number or SSN / EIN if Business
Physical Address of Ownels Cunent Legal Residence or Business City State Zip+4
Primary Lienholder Name l\,,lailinq Address City State Zip+4
ooE.C
a=Secondary Lienholder Name l\,lailing Address City State Zip+4
D€aler's Selleas Permit No. Lesso/s Seller's Pemit No. oelivery Date
I
]Gross Iaxaole Sales Pr'ce (lnclLde Ta)€ble Feesr $
o
{i
u)*
I
lAdiusted Gross Sales Price................................ $
lTrade-tn Attowance....................--....................... $
F",t ot *.........,.
lrartqq!9qtec!.-.................................................. $
I E Tax Exempt - Enter the tax form number used
lTradeJn lnformationlvear-Make
Rebates Motor Vehicles Only)
ehicle or Hull ldenliflcation No. (VlN/HlN)
s
Bodyryee
jModelI
lf motorcycle/motorbike, the FMVSS sticker is present E yes E t to
I certiry under penalty of p€rjury pursuant to the law oI the State of ldaho that I
have physically inspeci€d the vehiclerlessel described In Section '1, and lhe
VIN/HIN and date of thb application are conecl. I have identified the person(s)
signing this application and witnessod their signature. I further certiry that all
information contained herein b true and conect lo the best of my knowledge and
bdiaf lalso release all inleresl in his vehicldvessel unl€ss I am listed as
lienholder or owner on this ap9l6?tion for title.
Au:l;ronze4ffiatwe f 7
ldaho Dealer NoDealer Name
lo"rto laar"""IPhone No
City
Date
Slate Zip+4
RDAo
,a!EE
oAEo
x
TitG
.i g
3 e.0tu> ta
By signing bolow, t certity under penalty of perjury pursuant to tho law of the State of ldaho to All of the following stalements: that lhe vehicle/vessel doscribed
abov6 is 6wred by me airo t ner6uy mit<e appiication for a Certificate of Title for said vehicle/vessel; that this vehicldvessel will not be subject to a lien prior to
aeceipt ofthe title unlqss indicated: thal all information contained herein is kue and corect to the best ofmy knowtedge and beliet;that this vehicle willb€
continuously insured as prescrib€d by ldaho Code 49-1229; and that the signature below is my lrue and l€gal signature.
Applicant'6 Signature(s)Date Da)4ime Phone Number
(ixx
Pink - Purchas€r Copy Temporarv Rsqistration / Ownershio Documents - Keep in vour vehicle until vou pressnt il to lhe DMV for Dermanenl documenls.
5l ?r
LI
1,4:li ing Address ii d fierent from Owner s CLrrrent Legal Rcs dence C iy
tA
Siate ZiP+4
3414
AI FI
5 /?s 122
I TE
LAYION AVE
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 1 of 8
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 2 of 8
121018)
Bem ie. GEllrl SIATE WAIEB COlrlPAl{Y, LLCPlrchas€. GEi, SIATE WAIEB CO PAI{Y, LLC
Operalor I O.: u373543 u184a68Fu.dingSou,cer PaFrlledi)
PAY To THE oRDER oF **MIKE WHITE FOBD*-
Nlay 26,2022
**Eighty-Five Thousand Seven Hundred Forty-Six and 94/100 -US Dollars *" **$85,746.94**
vorD rFovER us s 85,746 94
0006382 11.24 CASHIER'S CHECK SERIAL #: 0638203126
ACCOUNT#: 4861'511582
WELLS FARGO BANK, N.A
114 E APPLEWAY AVE
COEUR D ALENE, ID 83814FOB INOUTRIES CALL [phone]
NOTICE TO PUBCHASER.IF THIS INSTRUMENT IS LOST,
STOLEN OR OESTROYED, YOU MAY REOUEST CANCELLATION
ANO BEISSUANCE. AS A CONDITION TO CANCELLATION AND
REISSUANCE, WELLS FARGO & COMPANY MAY 1I\,4POSE A FEE
AND BEOUIBE AN INDEMNITY AGREEMENT AND BONO.
NON.NEGOTIABLE
FAOO4 (lO/19) Mr2or 1oo939s9
Purchaser Copy
Memo 2019 FORD
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 3 of 8
I6IP, 8'\ Uf :+Eh'rBTU8*1',,9 81S "(Excludes Medium Outy, lncomplete and Diesel EngineCARE plans)
(&lu
Vehlcle ldentitlcation Number (,,VtN") (12 Digits)
1FT8W3DT1KEG,17243
Slgnaturo Oate
05t2612022
lnlomet Salo lpp IPP Term Curront Mlloage
36095lf
Warranty Start Oat€
09t24t2A19
PROTECT
FBAJL-CPO Upqrade Plans
! ran 1eora1
_ FBA (Bluo)
L-CPO
Non.CPO Wraps
Powertrain
Surchargos:
f- 12 Months/l2,OOO N4ites
f 36 [,,lonthsi36,OOO Mites (Ford Competitive Make) or 48 Months/so,OOO Mites (Lincotn Vehictes)
Spocialty - Emergoncy (Fire, Ambutance, police [Non-Ford], Limo, Livery, Shunb, Tow T.uck)
f lSnowplow E commerciat use
Now Plan Coverage: (Coverage begins at Warranty Sta rt Date and Zsro L4iles)
Core or FBA Gold (Ford) Upgrade ^ powertrainCARE, BaseCARE, ExlraCARE, Premi (Standard Deductible is $100)LCPO (Lincoln)- PremiumCARE (Standard Deductibte is $100
UmCARE
PowortralnCARE Wraps - (Standard Deductible rs $1OO)LeasoCARE - New PremiumCARE wi$ Wear ttems (Slandaro
Rent.|CARE - (Standard Deductibte is g0)
FBA(Blu€U
D6ductible is $0)
Used Plan Covorago: (Cover
Core - PowodrainCARE,age beglns al Signature
ExlraCARE,PremiuhCARE (Standard Deductible is $100)
Dat€ and Cunent Mil6s)BaseCARE
rad6 (3 months/4,000 mll€s)- PowortraincARE, BaseCARE, ExtraCARE, premiumCARE (Standard Deductibje is $100)
PLAN COVERAGE Deductible Plan T€rm Plan Erplratlon . (Earllost o0 Purchaso Sales Tax Total purchase price
X New Jusso Month Mileage Oate Price with Sales TarMileage
PremiumCARE $100 72 140000 09t2412025 't40000 4475 0.00 s4475.00
optlons f] Enhanced Rental ]PickUp&Delivery f]Key SoNicos Del€te -] lntorjor/Exterio. Lighting Delele f First Day Rentat Detere
DISCLOSURE INFORMATION:
THIS IS NOT AN INSURANCE CONTRACT. THE PURCHASE OF THIS AGREEMENT IS NOT REQUIRED IN ORDER TO
PURCHASE, OR OBTAIN FINANCING FOR A MOTOR VEHICLE. YOU MAY PURCHASE THE SERVICE CONTRACTBY CASH OR UNSECURED CREDIT CARD. IF YOU ELECT TO PURCHASE THISAGREEMENT, IT GIVES YOU SPECIFICLEGAL RIGHTS, WHICH MAY VARY FROM STATE TO STATE. I acknowledge receipt ot a complele copy ot this Appticaiion and
Terms and Conditions (the "Agreement") at signing and agree to all the terms and conditions. I agree to maintain the covered vehicle inaccordance with the manufacturefs stated periodic maintenance recommendations as a conditiotot receiving coverage under this Agreement,except as otherwise provided by law.
SERVICE CONTRACT HOLDERYPURCHASER
Name
GEM STATE WATER COMPANY LLC
Signatu Valid Signature)Signature Dato
05t2612022
Address
250 NORTHWEST BLVD STE 203 COEUR D ALENE ID 83814
Custome/s E-Mail Address
[e-mail]
tract L enholder Name
CASH
DEALE HIP NFOR
Dealership n
Telephone No
Address (City/State/Zip Code)
315 Clayton Avenue Coeu. D Alene lD 838159293
366 P&A CodeEmployss Stars ld
40310030021
tr
t-/
Deal6r Nam6
Mike White Ford Of Coeur d'Alene
FPLP 8250 . NAT WKEY (OCT 2021)
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 4 of 8
+Hirr$tt r.rP LAN A P P Lr cAfl o N,
NEWAND USED VEHICLES
@ ls
F5l8?EC'r
Vchlcle ldentlflcation Numb€r (,,VtN,') (17 Dlgtts)
1FT8W3DT1KEG17243
lnternet SaloI IPP TermIPP
t-
Slgnatu.o Dato
05t26t2022
Curront Miloage
36095
_ Gas/Hybrld
-t Diesot
[] Electric
I cPo
lncomplete
Medium Duty
Pbmium Malnlenanc. (PMp) L ] 12 Monthsh2,Ooo Ldiles
Extrt Maintonanco (xMP) r 36 Months/36,000 Miles (Ford/competitive [4ake) or 48 l\40nths/50,000 Miles {Lin60tn vehicles onty)su.cha.ges. f sno*po*
'Notfupit€bte tor CpO :-I Sp"ciatty - Erergency (Fire, Ambulanco), police, Limo, Livery, Shutde, Tow Truck)
Plan Termlllonths Mileage
EXTRA-MAINTENANCE PLANS (xMP): Gas/Hybrid/Diesel (Excludes Lincoln Vehictes)- (Slandard $o Deductibte)For PMP and XMP, Coverage BEGINS at lhe New Vehicle Limiled Warranty Stad Date and zero t ites. Coveraqe ENDS at THE EARLTER OFthe Number of Years Purch;sed rhe Numberof Mitea iurir'i""a oi lpon 16.pi"ir""'lii,ir,"" frlr'lri,l]ii"r.ri,ilZi'"i s"rvice tnrervats purchasedfrom the New Vehicte Limited Warranty Start oite oi zeio ff,iir;;. - *- "
LIMITED (LMP), BASIC (BMP), AND ENGINE MAINTENANCE (EMP) PLANS: GavHybrid/Dieset - (Standard $0 Deductibte)Coverage.BEGINS at the Signature Date and Currenl Miteage. Coveraqe ENDS at THE EARLTER Oi the Number ot years purchased, the
Mlig;bn";.ot tttit"" ewchased 6r upon comptetion or ttre Miiim'um r'rrmoe? oi srlrvicl r;i;*;;'ifi.n;;;irr-om-r'r,Jsisnatrre oai"'oibrii""i
(Standard $0 Deductibte)
PREMIUM MAINTENANCE PLANs (PMP): Gas/Hybrid/Dieser, Erectric, Lincorn, Brack Laber, rncomprete (cab/chassis), Medium Duty, cpo -
PLAN COVERAGE
Plan Name Plan Expiration (Earlaer of)Oate Mlleage
Purchase Sahs Tax
Pdce
Total Purchase
Price with Sales Tax
Premium Maintenance (PMP)
Exlra Maintenanc€ (XMp)
Plan Options
DISCLOSURE INFORMATION:
S gna ot Valid without Slgnature)
L/-
Add
100000 05t26t2028 136095P 2660 0.00 $ 2660.oo
E First Day R6ntal (Not avaitabte on lncomptet o, Uradiiutyll
Full Synlhelic Oil Oplion \NoI ava abte on XMP)
E Pick Up and Deliv€ry Option
f:,OOO' f, S,OOO f- z,SOO f ro.ooo(Required for p[.4p Etoctric)
'Not available on PMP Plans
Service Visits
20
Llmited Malntenance (LMP)
Plan Optlons Full Synthetic Oil Option
rygl-E_ ItlF PURCHASE OF THIS MAINTENANCE PLAN lS NOT REQUIRED lN OROER TO PURCHASE, OR OBTAIN FINANCING FOR
A!'rgJ-_o,! YFHtcLE. t acknowtedge receipt ot a comptete coiiTi iiisjiiintenaic6 iai tti" Aiiiiaiir'ij"iis'ana. conaiiiii Ziiniriir,ret!9 lIlire Maintenance Plan') at the time ol signing aid agree to allthe terms and conditini. i aoieE to iiiitiii ine covered vehicte inaccoroance wttn lne manufacturels slatad periodic mainlenance recommendalions as a condli6n of recieving covetaga under tiiiMaintenance Plan except as otherwise providei by hi:- -
MAINTENANCE PL.AN/PU RCHASER
Name
GEM STATE WATER COi\4PANY LLC
E-MailAddress
[e-mail]\4
Signature Date
05n612022
p ode)
250 NORTHWEST BLVD STE 203 COEUR D ALENE ID 83814
Maintenance Plan Lienholder Name
DEALE HIP INFOR toN
Dealership ture
Deal
Mike White Ford Of Co6ur dAlene
Address (City/Slate/Zip Code)
315 Clayton Avenue Coeur D Alene tD 838159293
Employee Stars ld
Telephone No
o o iz olo 7
FPLP 8324 MNTC (JAN 2021)
36 6
P&A Code 04031
Warranty Start Oale
09t24AU9
I Limitod Maintenanco
Service lntervals
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 5 of 8
June 30, 2022
|DAHO PROOF OF REGTSTRATTON (PLATES ON ORDER)
TITLE NO.STICKER NO REG ISSUED REG EXP DATE WEIGHT CLASS vtN
KAM552 220395356 06128t2022 06t30t2023 26000 1FT8W3DT1KEG17243
YEAR DESCRIPTION
2019 FORD F350
ldaho Transportation Oepartment I Division of MotorVehicles I PO Box 7129 | Boise. lO 83707-1129
ffi
GEM STATE WATER COMPANY LLC
250 NORTHWEST BLVD STE 203
COEUR D ALENE,ID,83814
l/w€ certify under penalty of law that this vehicle is and will be
continuously insured as prescribed by law. (see reverse side)
APPLICANT MUST SIGN TO BE VAIIO
RECEIPT NO REGISTRATION ALONE IS NOT PROOF OF OWNERSHIP AND MAY
NOT DISPLAY ALL OWNERS AND LIENHOLDERS
SECTION ONE:
CUT THIS OOGUMENT HORZOT{TALLY BETWEEN THIS BOX ANO THE BLUE AND ORANGE LOGO. DISPLAY THE BOTTOM HALF OF THIS
DOCUMENT ON YOUR VEHICLE ACCORDIiIG TO THE DIRECTIONS BELO}Y It{ SECTIOT{ 1
IDAHO PROOF OF REGISTRATION (PLATES ON ORDER)
vEHrcr.E TDENTTFTCAT|ON NO.1FT8W3Dr1KEG1724! Expircs: 0611012023
Plate No:
I(AMs52
SECTION TWO
DISPLAY THIS SECTION OF THE FORM SECURELY IN THE REAR WINOOW OF YOUR VEHICLE OR SOMEWHERE VISABLE ON YOUR
MOTORCYCLE. (BE CAREFUL NOT TO OBSTRUCT YOUR VIEW)
IMPORTANT CUSTOMER INFORMATION
Your now license platg is now on order. You should receive it in th6 mail in approximat€ly four (4) we€ks. This proof of validation willallow you lo
drive yourvehicle untilyour new plates ariv6. REMOVE ANY OTHER CLASSIC PLAIE CURRENTLY ON THE VEHICLE-
1. The top ponion ofthis form is the proof ofvalidation document for your vehicle. Sign the form and keep this section in your glove box. Please DO
NOT display this in yourvehicles rear (back)window. This document has your pgrsonal infornation prinled on il and should not be displayed.
2. The bottom portion ofthis fo.m will n6ed to be displayed on the inside lowerdiver side ofyour rear (back) window in a way thal does not obstruct
your view. This portion does nol rovoal personal information and will allow you to drive your vohicle appropriately while you await your new license
plate. For motorcyclos the middl€ porlion ofth€ form should b6 placed som6wh6re saf6 and visible on your motorcycls.
3. Onc€ you have receivsd your new plat6 remov€ lh€ middle portion of this form from your v6hicle. Pleas€ insure you sign your new validation
document and keep it in your car.
4. Once you have rec€ivod your new plates put the n6w registration stickeB on th6m and Bmove the middla portion ofthis form from yourv6hicle.
Please insure you sign your new registration document and keep it an your car.
FORM 1301 Kr-Jo
PLATE NO.
MAKE MODEL
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 6 of 8
6l2\t22 9:55 AM
Status:
Customer Name:
Type:
Credit Card Number
Items
Point-of-Sale Payments
pAHOrt-"ntnrno
F'URCHASE RECEIPT
Kootenai County Assessor
P.O. Box 9000
Coeur d Alene lD 83816
[phone]
OTC Local Ref lO: 71720802
612812022 09:55 Atvl
Your credit card or bank statement will show a charge from KootenaiDNIV
Quantity
APPROVED
RAYNER/LESLIE
MasterCard
TPE Order lO Total Amount
Total
Note: s6618274
Customer Phone Number: 1
Clerk's lnitials; cb
1 52670544 $209.83
Total remitted to the Kootenai County Assessor s209.83
Access ldaho Fee 52670544 5b, ZY
Total Amount Charged s216.12
lo offer the convenience of using your bank card, a service fee of 3% has been added to your
transaction. This fee goes to our third-party provider, ldaho.gov. The County does not keep any portion
of this fee.
https://olc.cdc.nicusa.com/Receipt.aspx?src=csh 2i?
1
Signature
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 7 of 8
ITD 3517 (Rev. 12-19)
Supdy # 018755298
VEHICLE IDENTIFICATION NUMBER
ISSUE DATE
06113/2022
OWNER'S NAME AND ADDRESS
GEM STAIE WATER COMPANY LLC
OTHEB PEBTINENT DATA
250 NORTHWEST BLVD STE 203
COEUR O ALENE ID 83814
Assignment of TitleWaming: lt is a felony to enter a false selling price. name, or address, or lo alter or forge this document. Federal and State laws require
1FTBW3DT1 KEG17243
2ND VEHICLE IDENTIFICATION NUMBEB
when transfeni motor vehicle ownersh Failure to com
ometer Reading - Reading is actuat untess indicated olherwise
(No tenths)Reading Datelln Excess of l\,lechanical Limits Exempt
E Not Actuat - wam : Odometer
YEAR
2019
BODY
PK
MODEL
F35
TITLE NUMBER
220395356
you to state the
nment.
t\4AKE
FOBD
No Device rB
il
Selling Price
rov d false information ma result in fines and/or im
s ild PufctBsels PnnEd Fdl L€gal Name/ ldaho Odveis UcelE6 ilo. o. SSN; EIN il Blsin€€s
Purcitseis Pnnted Full Leg6l flame / ldaho D.iv6/s Ucense l.Jo or SSN: EIN if &Eir!€ss
Ma ing Address a!!l Physical Address {if ditferen0
Selb/s or Repres€ntalive's Pinted Name(s)cnv state zp3
BX
rl €nit. b ttc beEa d my krbxLdge. tllaa tlE odonE{e. I€dng €ie6 trE aArat nit€qE.4 ,(,llas alr8ri* ird(aEd I dso tEeby t-a.*. trsJ+ b IE rsried Frt*86. I rcdiu I'rrrd fle a rd€6e o, td&y saenErr eifil nle daF oa dafve.iE fE €ri* b fE p( EtE-
isell€/s or Repr6entattveb S(fatre
rla
llt I apdy ,u tite in ldatE. I k/u., I .rn st (b so sthn 30 days o{ puctais o. a $0 m lata
E fling Fidly,ra b€ d.E. I am a€re oa the o.b.rEGr cartificdion ftEd6 Dy th€ s.ller.
1rR dlass/s S€natue (0. Repr€aent6lire's Silnat e)
eX
I
'1n ArDha66as SignanJre (or Reg€s€otalive's P.i.ted Narie)
sX
Lbnholder Section
First Li€n Second Lien
rsignaur€ Releasing Lbn
roix
Ne{ Uenhdde/s N3rne / Ehrl (l.Js6 ldaho div€ds lc€rBe * o. SSN it irdyktd)
slate 7+a r'ab f uu
1FT8 ,17243Sdks Prinled Fu[ Legd ilanE / tda]E Drns!,s Licerue tto. d SSN: Er
laaihg Add.ess qAC PhFcal Address (if d,ffereoo
Slate Z9
Odonteter R€ading
Da:e
11
12
m19
N if B.lirEs Purdlaseis
,Slgnature Reieasi rO Lien
,lx
(Rer.,2rs) $3.50 Fee* Release of Liability Statement $3.50 Fee*
Please Print Clearly - All lnformation l{usl qe_ q9!!p!49 _llolifiSat1gn by Jeller{ransturor is tlandatory for Xtotor Vehicles_Vetide or Hu$ ldenlifcalton NLnnber (VtN/HlN) year Make Bodv TyDe f,{€ Number
_l ORD PK 220395356
Pnned Full Legal Narne / ldaho Dnvels Li:ense t{o- or SSN: Et|{ if Brrsin6s
Mailing Mdrcss qld Physical Addr€ss ( drfferenl)
Ciil Slale Zp
S€ling Pice
$
Oate Vehbe Delivered ro Purch6er(s) - See reyerse side for mailing and
paymenl instructions -
I hrr€by rc$l€$ thd 6. Ia^Iro Tno+oaioa Depanmr nurk its ,Ecords to show tbe vehicle descnH above bas b€€a Fartsferred-
reccd will romin ia t}ty n.D rmtil a new ldaho C€nificare of Title is ryplied for ad issued in the Datrqs) of l}re Eew owD<s).
gcllaf sff ,anslatof 6 Signaure X
'F.. tugad lo dlan0ts. Bstore sending $b notics, de6e visit d.nv.idaho.oov to verify the dlnent fee.
ING
36095 ACTUAL
ODOMETER
PRINT DATE
o6t14t2022
LENGTH
I
WEIGHT
0
WDTH
I{
I rmderstaod drar the tide
ODOMETER REAOING DATE
o5/25t2022
I
.W -at
T 13
GSW-W-22-01 IPUC DR 2 Attachment 2 Page 8 of 8